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Thera VII > 28 Microbial Prophylaxis Goad > Flashcards

28 Microbial Prophylaxis Goad Flashcards

1
Q

Who should have infective endocarditis phrophylaxis?

A

High risk patients going in for dental procedures

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2
Q

Which dental procedures need prophylaxis for high risk individuals?

A

Extractions. Cleaning. Root canal surgery. Periodontal surgery. Intraligamentary injections

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3
Q

Which patients are considered “high risk” for infective endocarditis?

A

Highest-Risk Cardiac Conditions (Prosthetic heart valves, Previous IE, Congenital heart defects, Cardiac transplant with valvular regurgitation). Intravenous drug abuse

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4
Q

When is prophylaxis for IE NOT recommended?

A

Shedding of primary teeth. Adjustment of orthodontic appliances. X-rays, fluoride treatments, oral impressions. Restorative dentistry

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5
Q

What medications are used for High Risk patients going in for Dental Procedures?

A

Amoxicillin 2g 30-60min prior to dental procedure. Cephalexin as an alternative

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6
Q

What medications are used for High Risk patients going in for Dental Procedures who are unable to take oral medications?

A

Cefazolin 1g or Ampicillin 2g IM/IV 30-60min prior to the dental procedure

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7
Q

What medications are used for High Risk patients going in for Dental Procedures who are allergic to Penicillin?

A

Clindamycin 600mg PO/IV or Azithromycin 500mg 30-60min prior to procedure

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8
Q

What does the Spleen do?

A

Helps with immunity. Removes old RBCs

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9
Q

How can Asplenia occur?

A

Surgical or congenital. Functional (e.g. sickle cell anemia)

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10
Q

What is the Overwhelming Post-Splenectomy Infection (OPSI) caused by?

A

Encapsulated bacteria (S. pneumoniae, H. influenza, N. meningitidis). S. aureus. Gram Negative (E. coli, K. pneumoniae, Salmonella, Capnotcytophagia (from dog bite)). Babesia (east coast, from ticks). Malaria (not in US)

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11
Q

What is Asplenic Prophylaxis for < 5 yo?

A

PCN 125mg PO BID

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12
Q

What is Asplenic Prophylaxis for 5+ yo?

A

PCN 250mg PO BID

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13
Q

What is Asplenic Prophylaxis thats an alternative to PCN?

A

Amoxicililn (20mg/kg/d)

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14
Q

What is Asplenic Prophylaxis for Sickle Cell Anemia (+ other causes of functional asplenia)?

A

Stop at 5 years of age of daily prophylaxis unless: h/o severe pneumococcal disease, surgical splenectomy

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15
Q

What is Asplenic Prophylaxis for > 5 yo and h/o IPD or surgical splenectomy?

A

At least 2 years after surgery. Chronic Abx proph is controversial. Provide stand-by Abx treatment

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16
Q

What are the immunizations recommended for Asplenic Prophylaxis?

A

Hib (4 doses (2, 4, 5, 12-15 months of age). 1 dose for adults). Pneumococcal (PCV13 (2, 4, 6, 12-15 months of age) + PPSV23 (> 2 years of age + 5 years later). Meningococcal (MCV4 (2 doses: > 2 years of age + 2 months later). MCV4 Q5 years thereafter)

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17
Q

What is the summary for recommendations of 23-Valent Pneumococcal Vaccine?

A

Adults 65 years of age or older OR 2-64 year olds with: 1) A normal immune system who have chronic illness (heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of CSF). 2) Immune dysfunction and altered resistance to infection (HIV/AIDS, oncologic, steroids, asplenia, kidney disease, transplant)

18
Q

What is the PCV13 and PPSV23 recommendation for persons with functional or anatomic asplenia (sickle cell disease/other hemaglobinopathy, congenital or acquired asplenia) with NO previous PPSV doses?

A

PCV13 –> 8 weeks –> PPSV23 –> 5 years –> PPSV23

19
Q

What is the PCV13 and PPSV23 recommendation for persons with functional or anatomic asplenia (sickle cell disease/other hemaglobinopathy, congenital or acquired asplenia) with 1 previous dose of PPSV?

A

> 1 year –> PCV13 –> 5 years –> PPSV23

20
Q

Why may some patients get 3 doses of PPSV23?

A

If their final dose of PPSV23 was before age 65 and its been at least 5 years

21
Q

What is Chemoprophylaxis for Meningitis?

A

W/in 24 hrs of exposure, limited after 14 days. Eradicates nasal carriage during an epidemic. Close contacts of infected person should get it (family, day car)

22
Q

What is Immunization for Meningitis?

A

Quadrivalent conjugate vaccine (A, C!, Y, W135). Eradicates nasal carriage over time Indications (functional asplenia, travelers to Africa, outbreaks)

23
Q

What is the usual drug used for Chemoprophylaxis for Meningococcal Disease?

A

Cirpofloxacin 500mg single dose

24
Q

What are the two Meningococcal Vaccines?

A

Menomune (pure polysaccharide): 2+ yo, no upper age limit. Menactra or Menveo (conjugate): Menactra (9 months) & Menveo (2 years) up to 55 years, routine (11-12 yo + 16 years (2 doses), “boostable” & eradicate nasal carriage, Q5 years while at risk

25
Q

What are the two main outer membrane structures of Influenza virus that are most important to look at?

A

NA (Neuraminidase) and HA (Hemagglutinin)

26
Q

What is the PO influenza antiviral that is commonly used?

A

Oseltamivir (Tamiflu): 1+ yo, GI ADRs. Zanamivir (Relenza): 7+ yo (5+ yo for chemo-prophylaxis), not recommended for people w/ underlying respiratory disease (allergic reaction can cause oropharyngeal or facial edema)

27
Q

What is the difference between Oseltamivir and Zanamivir?

A

Both dosed 1 QD. Oseltamivir can be used 1+ yo, while Zanamivir is 5+ yo. Oseltamivir is a 6 week treatment course while Zanamivir is 28 days. Oseltamivir is more efficacious

28
Q

What is the DOC for postexposure prophylaxis for Pertusis?

A

Azithromycin. 10mg/kg/day x5 days for children. Adults: 500mg single dose day 1, 250mg single dose days 2-5

29
Q

What is the recommendation for Tdap?

A

7+ yo, no upper age limit. For routine vaccination of adolescents 11-12 yo. Approved for one-time administration (except pregnancy). Two available products: Boostrix (10+ yo), Adacel (11+ yo)

30
Q

What is the Tdap interval between Td and Tdap like?

A

No minimum interval (Td –> Tdap). Wound management (Tdap –> Td) 5 years. Routine (Tdap –> Td) 10 years

31
Q

What is Tdap use like in pregnancy?

A

No evidence of teratogenicity. Give Tdadp during pregnancy (preferred > 20 weeks). May also give post-partum if not given during pregnancy. Give a dose for EVERY pregnancy!

32
Q

What are the characteristics of Haemophilus Influenzae type b (Hib)?

A

Gram (-) coccobacilli. Polysaccharide capsule (invasive form): meningitis, epiglotitis. H. flu non-typable: common URIs. Recommended vaccination for children: 2, 4, 6, 12-18 months

33
Q

What is given as Hib Prophylaxis?

A

Rifampin PO. Adults: 600mg QD x4 days

34
Q

What are the characteristics of Hepatitis A?

A

Fecal-oral transmitted virus. Incubates 15-50 days. S/Sx: fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice. Self-limiting disease. No chronic disease

35
Q

What is the pre-exposure Hepatitis A prophylaxis for Travelers?

A

> 4 weeks before travel: Hep A vaccine. < 4 weeks before travel: 1-40 yo: Hep A vaccine, < 1 or > 40: IgIM

36
Q

For pre-exposure prophylaxis of Hepatitis A, how is Immune Globulin dosed?

A

0.02 ml/kg < 3 months protection. 0.06 ml/kg = 5 months protection

37
Q

What is Post-Exposure prophylaxis for Hepatitis A?

A

Given w/in 2 weeks of exposure. > 85% effective. Hep A vaccine for 1-40 yo, IgIM for < 1 or > 40yo

38
Q

What are the highest risk factors for Hepatitis B?

A

Multiple sex partners. IDU. MSM

39
Q

What should be done after Hepatitis B Exposure?

A

Start PEP w/in 1 week of exposure. Up to 62% will seroconvert. Vaccine +/- HBIG

40
Q

What are the “Quick Shots” available?

A

HPV4 (now recommended for boys 11-12 yrs and 13-21 yrs for catch-up). Hepatitis B (recommended for all people w/ DM < 60 yrs, permissive for those over 60 yrs)

Thera VII (37 decks)

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